Introduction NICE and BSG have recommended the use of faecal calprotectin (FCP) in investigating patients with suspected small bowel Crohn’s disease (SBCD). There is currently inadequate data to advise on management for intermediate ranges of FCP of 50 ug/g to 250 ug/g. This study aims to assess whether this intermediate FCP level is clinically significant for diagnosing active SBCD.
Method We analysed patients with suspected SBCD at Hereford County Hospital from 2013–2016 who underwent SB imaging and FCP testing. Patient’s notes, laboratory results and clinical imaging were reviewed and Fisher’s exact test was used for statistical analysis.
Results 48 patients underwent FCP with small bowel cross-sectional imaging. For those with an elevated FCP >250 ug/g, there was a positive predictive value of 75% for diagnosing SBCD and a negative predictive value of 70% for those with an FCP <50 ug/g (p=0.02). 10 patients had an intermediate range between 50–250 ug/g of which 70% (n=7) were diagnosed with CD. See Table 1 for full details.
Of the three patients in the intermediate range who had normal scans, 1 patient had an FCP of 63 which then rose to 173. Although the CTE was normal, the colonoscopy showed mild erythema in the caecum. Subsequent biopsies were normal. A further OGD and USS abdomen were normal. This patient was diagnosed with non-ulcer dyspepsia and irritable bowel syndrome. Patient 2 had an FCP of 86 who was under the care of surgeons for previous adhesiolysis secondary to hysterectomy. A CTE was negative and a colonoscopy only showed haemorrhoids. Patient 3 has known SBCD with previous right hemi-colectomy. The FCP was 238 and CTE showed a narrowing of the anastomosis at the terminal ileum. Colonoscopy confirmed a non-inflammatory stricture that required dilatation.
Conclusion Despite a small sample size, our study suggests that an intermediate FCP level of 50–250 ug/g has a PPV equivalent to FCP >250 ug/g and should therefore be considered as a significant finding.
Disclosure of Interest None Declared
- Crohn’s disease
- FAECAL CALPROTECTIN